Citation Nr: 0313197
Decision Date: 06/18/03 Archive Date: 06/24/03
DOCKET NO. 96-44 182 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Atlanta,
Georgia
THE ISSUES
Entitlement to an increased initial rating for post-traumatic
stress disorder (PTSD), currently evaluated as 50 percent
disabling.
Entitlement to an increased rating for bronchitis, currently
evaluated as 60 percent disabling.
REPRESENTATION
Appellant represented by: Georgia Department of Veterans
Service
WITNESS AT HEARING ON APPEAL
The Veteran
ATTORNEY FOR THE BOARD
Elizabeth Spaur, Associate Counsel
INTRODUCTION
The veteran had active service from October 1942 to March
1946.
This matter comes before the Board of Veterans' Appeals
(Board) on appeal from June 1996 and February 1997 decisions
by the Department of Veterans Affairs (VA) Atlanta, Georgia,
Regional Office (RO). The June 1996 decision continued a
rating of 10 percent for bronchitis. The February 1997
decision granted service connection for PTSD and assigned an
initial rating of 30 percent. A September 2002 rating
decision increased the disability rating for bronchitis to 60
percent and increased the disability rating for PTSD to 50
percent. As neither increase represents the full benefit
sought, the issues remain on appeal.
The veteran had testified before a Member of the Board at a
videoconference hearing in August 1997. At the hearing, the
veteran testified that the only issue on appeal was
entitlement to an increased initial rating for PTSD. The
Member of the Board who presided over the hearing was unable
to participate in the decision. The veteran was asked if he
would like another hearing before the Member of the Board who
would be deciding his claims. The veteran requested another
hearing. The Board remanded the claims in August 1998 for a
hearing before a Member of the Board. In addition, the Board
requested clarification as to whether the veteran wished to
pursue his appeal with regard to the issue of entitlement to
an increased rating for bronchitis. In a July 2000 letter,
the veteran withdrew his request for a second hearing and
asked that the Board consider both issues currently on
appeal.
The Board notes that the September 2002 rating decision also
found the veteran entitled to benefits based on individual
unemployability, finding that the veteran was unable to
obtain employment as a result of all his service connected
disabilities.
FINDINGS OF FACT
1. All evidence necessary for review of the issues on appeal
has been obtained, and the VA has satisfied the duty to
notify the veteran of the law and regulations applicable to
the claims, the evidence necessary to substantiate the claim,
and what evidence was to be provided by the veteran and what
evidence the VA would attempt to obtain on his behalf.
2. The evidence of record reasonably shows that the
veteran's PTSD is not currently manifested by occupational
and social impairment, with deficiencies in most areas, such
as work, school, family relations, judgment, thinking, or
mood, due to such symptoms as: suicidal ideation;
obsessional rituals which interfere with routine activities;
speech intermittently illogical, obscure, or irrelevant;
near-continuous panic or depression affecting the ability to
function independently, appropriately and effectively,
impaired impulse control (such as unprovoked irritability
with periods of violence); spatial disorientation; neglect of
personal appearance and hygiene; difficulty in adapting to
stressful circumstances (including work or a worklike
setting); and inability to establish and maintain effective
relationships.
3. The evidence of record reasonably shows that the
veteran's bronchitis is not productive of pronounced
disability, with copious productive cough and dyspnea at
rest; pulmonary function testing showing a severe degree of
chronic airwave obstruction; or symptoms of associated severe
emphysema or cyanosis and findings of right-side heart
involvement. Neither is there a FEV-1 less than 40 percent
of predicted; a FEV-1 /FVC less than 40 percent; or a maximum
exercise capacity less than 15 ml/kg/min oxygen consumption
(with cardiac or respiratory limitation); cor pulmonale
(right heart failure); right ventricular hypertrophy;
pulmonary hypertension (shown by echo or cardiac
catheterization); or episodes of acute respiratory failure or
requiring outpatient oxygen therapy.
CONCLUSIONS OF LAW
1. PTSD is not more than 50 percent disabling according to
the schedular criteria. 38 U.S.C.A. § 1155 (West 2002); 38
C.F.R. § 4.130, Diagnostic Code 9411 (2002).
2. Bronchitis is not more than 60 percent disabling
according to the schedular criteria. 38 U.S.C.A. § 1155
(West 2002); 38 C.F.R. § 4.97, Diagnostic Code 6600 (1996 &
2002).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
I. Duty to Assist
As an initial matter, the Board observes that, during the
pendency of this appeal, substantial revisions have been made
to the laws and regulations concerning the VA's duties in
developing a claim for a VA benefit. On November 9, 2000,
the Veterans Claims Assistance Act (VCAA), Pub. L. No. 106-
475, 11 Stat. 2096 (2000) was enacted. The VCAA redefines
the VA's obligations with respect to its duty to assist the
claimant with the development of facts pertinent to a claim
and includes an enhanced duty to notify the claimant as to
the information and evidence necessary to substantiate a
claim for VA benefits. This change in the law is applicable
to all claims filed on or after the date of enactment of the
VCAA or filed before the date of enactment and not yet final
as of that date. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A,
5106, 5107, 5126 (West 1991 & Supp. 2002). See also Karnas
v. Derwinski, 1 Vet. App. 308, 312-313 (1991).
The final rule implementing the VCAA was published on August
29, 2001. 66 Fed. Reg. 45,620-45,623 (Aug. 29, 2001)
(codified as amended at 38 C.F.R. §§ 3.156(a), 3.159 and
3.326(a) (2002)). These regulations, likewise, apply to any
claim for benefits received by the VA on or after November 9,
2000, as well as to any claim filed before that date but not
decided by the VA as of that date, with the exception of the
amendment to 38 C.F.R. § 3.156(a) (relating to the definition
of new and material evidence) and to the second sentence of
§ 3.159(c) and § 3.159(c)(4)(iii) (pertaining to VA
assistance in the case of claims to reopen previously denied
final claims), which apply to any application to reopen a
finally decided claim received on or after August 29, 2001.
See 66 Fed. Reg. 45,620 (Aug. 29, 2001).
In this case, the Board finds that all relevant facts have
been properly developed in regard to the veteran's claims,
and no further assistance is required in order to comply with
the VA's statutory duty to assist him with the development of
facts pertinent to his claims. See 38 U.S.C.A. § 5103A (West
Supp. 2002); 38 C.F.R. § 3.159 (2002). Specifically, the RO
has obtained records corresponding to medical treatment
reported by the veteran and has afforded him VA examinations
addressing the disabilities at issue. There is no indication
of additional relevant medical evidence that has not been
obtained by the RO to date.
The VA's duty to notify the veteran of the evidence necessary
to substantiate his claims has also been met, as the RO
informed him of the need for such evidence in a November 2001
letter. See 38 U.S.C.A. § 5103A (West 1991 & Supp. 2002).
This letter, which includes a summary of the newly enacted
provisions of 38 U.S.C.A. §§ 5103 and 5103A, also contains a
specific explanation of the type of evidence necessary to
substantiate the veteran's claims, as well as which portion
of that evidence (if any) was to be provided by him and which
portion the VA would attempt to obtain on his behalf. The
specific requirements for a grant of the benefits sought on
appeal will be discussed in further detail below, in
conjunction with the discussion of the specific facts of this
case. See generally Quartuccio v. Principi, 16 Vet. App. 183
(2002).
II. Increased Rating for PTSD
Factual Background
Service personnel records indicate that the veteran served in
combat with multiple citations for combat participation.
A December 1996 VA examination report indicated that the
veteran was complaining of flashbacks to the war. The
veteran denied suicidal or homicidal ideations or auditory or
visual hallucinations. He reported that he was depressed and
did not like to socialize. On examination, the veteran was
alert, cooperative, coherent and goal-oriented. He was hard
of hearing and depressed. His affect was inappropriate. He
was oriented times three. Short-term memory was impaired.
The diagnosis was PTSD, chronic with depression.
Service connection for PTSD was granted in a February 1997
decision and an initial rating of 30 percent was assigned.
The veteran testified before a Member of the Board at a
videoconference hearing in August 1997. The veteran reported
that he experienced a lot of flashbacks. He also stated that
he had dreams relating to his military experience a couple of
times a month. He testified he believed his PTSD got worse
as he got older. He stated he got nervous and could be hard
to get along with.
VA treatment notes from October 1998 to August 1999 reported
that the veteran was alert, oriented in all spheres, pleasant
and cooperative. He had appropriate affect and responses to
questions. He was able to follow complex instructions. He
had good recent and remote memory. His intellect appeared
normal. He denied suicidal or homicidal ideations, intent or
plans.
An October 1999 VA examination report noted that the veteran
reported declining memory. He also stated the he felt
nervous, but could not define that any further or relate it
to precipitating events. On examination, the veteran was
casually dressed and neatly groomed. He was pleasant and
polite. Speech was of a normal rate, volume and tone. No
psychomotor agitation and no retardation were present.
Thought process was logical, coherent and goal directed,
without looseness of association, circumstantiality,
tangentiality, pressured speech or flight of ideas. His mood
was euthymic and his affect was appropriate. He was free of
suicidal ideation, homicidal ideation, hallucinations, and
delusions. He admitted to having heard his name called six
months prior when no one was there. He was oriented to time,
place, person and situation. His memory for recent and
remote events was intact. His insight and judgment were
fair. The veteran stated that he had flashbacks. He
indicated that he has not had nightmares while on
medications. He admitted to some startle reaction. No
hypervigilance or emotional withdrawal or other signs of
hyperarousal were elicited. A Global Assessment of
Functioning Score (GAF) of 70 was assigned.
The October 1999 VA examiner reported that the GAF of 70
implied some mild symptoms or some difficulty in social or
occupational functioning, but generally the veteran
functioned pretty well and had some meaningful interpersonal
relationships.
A December 2001 VA examination report noted that the veteran
reported having dreams about the war almost every night. He
reported waking up several times in the night in sweats and
admitted to kicking and fighting at night. He indicated he
had problems going to sleep. He stated that he had intrusive
thoughts during the day, but they usually did not interfere
with his functioning. He reported mild hypervigilance and
exaggerated startle response. On examination, the veteran
was casually dressed and cooperative with good eye contact.
His speech was a normal rate and volume and was coherent,
logical and goal directed. His thought processes were
logical and goal directed also. Thought content was without
any auditory or visual hallucinations. There was no paranoia
and there were no suicidal or homicidal ideations.
Cognitively, he was alert and oriented to person, place, time
and situation. His insight was limited and his judgment was
fair. The examiner assigned a GAF of 65.
The December 2001 VA examiner noted that the veteran had mild
symptoms of PTSD that caused impairment in social and
occupational functioning. The examiner also indicated that
it appeared the veteran's problems with hearing also
contributed to psychiatric problems. Finally, the examiner
stated that the veteran was unemployable.
Criteria
Disability evaluations are determined by the application of a
schedule of ratings, which is based on the average impairment
of earning capacity in civil occupations. See 38 U.S.C.A.
§ 1155. Separate diagnostic codes identify the various
disabilities.
The assignment of a particular Diagnostic Code is dependent
on the facts of a particular case. See Butts v. Brown, 5
Vet. App. 532, 538 (1993). One Diagnostic Code may be more
appropriate than another based on such factors as an
individual's relevant medical history, the current diagnosis,
and demonstrated symptomatology. In reviewing the claim for
a higher rating, the Board must consider which Diagnostic
Code or Codes are most appropriate for application of the
veteran's case and provide an explanation for the conclusion.
See Tedeschi v. Brown, 7 Vet. App. 411, 414 (1995).
The veteran is contesting the disability evaluation that was
assigned following the grant of service connection. This
matter, therefore, is to be distinguished from one in which a
claim for an increased rating of a disability has been filed
after a grant of service connection. The United States Court
of Appeals for Veterans Claims (Court) has observed that in
the latter instance, evidence of the present level of the
disability is of primary concern, Fenderson v. West, 12 Vet.
App. 119, 126 (1999) (citing Francisco v. Brown, 7 Vet. App.
55 (1994)), and that as to the original assignment of a
disability evaluation, VA must address all evidence that was
of record from the date the filing of the claim on which
service connection was granted (or from other applicable
effective date). See Fenderson, 12 Vet. App. at 126-127.
Accordingly, the evidence pertaining to an original
evaluation might require the issuance of separate or "staged"
evaluations of the disability based on the facts shown to
exist during the separate periods of time. Id.
Diagnostic Code 9411 provides that a 50 percent rating is
warranted for PTSD where there is occupational and social
impairment with reduced reliability and productivity due to
such symptoms as: flattened affect; circumstantial,
circumlocutory, or stereotyped speech; panic attacks more
than once a week; difficulty understanding complex commands;
impairment of short and long-term memory (e.g. retention of
only highly learned material, forgetting to complete tasks);
impaired judgment; impaired abstract thinking; disturbances
of motivation and mood; difficulty in establishing and
maintaining effective work and social relationships.
38 C.F.R. § 4.130, Diagnostic Code 9411.
A 70 percent rating is warranted where there is occupational
and social impairment, with deficiencies in most areas, such
as work, school, family relations, judgment, thinking, or
mood, due to such symptoms as: suicidal ideation;
obsessional rituals which interfere with routine activities;
speech intermittently illogical, obscure, or irrelevant;
near-continuous panic or depression affecting the ability to
function independently, appropriately and effectively,
impaired impulse control (such as unprovoked irritability
with periods of violence); spatial disorientation; neglect of
personal appearance and hygiene; difficulty in adapting to
stressful circumstances (including work or a worklike
setting); and inability to establish and maintain effective
relationships. Id.
A 100 percent rating is warranted where there is total
occupational and social impairment, due to such symptoms as:
gross impairment in thought processes or communication;
persistent delusions or hallucinations; grossly inappropriate
behavior; persistent danger of hurting self or others;
intermittent inability to perform activities of daily living
(including maintenance of minimal personal hygiene);
disorientation to time or place; and memory loss for names of
close relatives, own occupation, or own name. Id.
When all the evidence is assembled, VA is responsible for
determining whether the evidence supports the claim or is in
relative equipoise, with the appellant prevailing in either
event, or whether a preponderance of the evidence is against
a claim, in which case, the claim is denied. Gilbert v.
Derwinski, 1 Vet. App. 49 (1990).
Analysis
After having carefully reviewed the evidence of record, the
Board finds that the preponderance of the evidence is against
an increased initial rating for PTSD, currently evaluated as
50 percent disabling.
Medical evidence of record from the December 1996 VA
examination report to the December 2001 VA examination report
indicates that the veteran has been oriented to person,
place, time and situation consistently. He has reported no
suicidal or homicidal ideations. Speech has been noted to be
of a normal rate, volume and tone. The December 2001 VA
examiner specifically noted that the veteran's speech was
coherent, logical and goal-directed. The veteran has been
noted to be depressed. However, the veteran's depression has
not been noted to affect his ability to function
independently, appropriately and effectively. The Board
finds that such symptoms establish that the veteran's PTSD is
currently no more than 50 percent disabling. See 38 C.F.R.
§ 4.132, Diagnostic Code 9411. The Board notes that the
December 2001 VA examiner indicated that the veteran was
unemployable. However, he did not indicate that the veteran
was unemployable due to symptoms related to PTSD.
This determination is supported by the VA examiner's finding
that the veteran's PTSD symptoms are indicative of a GAF
score of 70, in October 1999, and 65, in December 2001.
Although the GAF score does not fit neatly into the rating
criteria, it is evidence, which the Court has noted the
importance of in evaluating mental disorders. See Carpenter
v. Brown, 8 Vet. App. 240 (1995). The GAF score is defined
as a scale reflecting the "psychological, social, and
occupational functioning on a hypothetical continuum of
mental health- illness." DIAGNOSTIC AND STATISTICAL MANUAL
OF MENTAL DISORDERS 46- 47 (4th ed. 1994). GAF scores of 65
and 70 (which fall within the range of 61-70) are defined as
"Some mild symptoms (e.g. depressed mood and mild insomnia)
OR some difficulty in social, occupational, or school
functioning (e.g. occasional truancy, or theft within the
household) but generally functioning pretty well, has some
meaningful interpersonal relationships." Id. Accordingly,
the veteran's GAF scores are indicative of no more than the
50 percent evaluation the veteran is currently receiving.
See 38 C.F.R. § 4.132, Diagnostic Code 9411.
The veteran is competent to report his symptoms. To the
extent that the veteran claims symptoms related to PTSD are
worse than the 50 percent evaluation contemplates, the Board
finds that the medical findings do not support such an
assertion. The Board attaches greater weight to the clinical
findings of skilled, unbiased professionals than to the
veteran's statements in support of a claim for monetary
benefits. To this extent, the preponderance of the evidence
is against his claim and there is no doubt to be resolved.
See Gilbert, 1 Vet. App. at 55.
The Board also finds that the evidence does not raise a
question that a rating higher than 50 percent is warranted
for any period of time from the veteran's claim to the
present time so as to warrant a staged rating due to
significant change in the level of disability.
The above decision is based on the VA Schedule of Rating
Disabilities. In Floyd v. Brown, 9 Vet. App. 88, 96 (1996),
the Court held that the Board does not have jurisdiction to
assign extra-schedular evaluations under 38 C.F.R.
§ 3.321(b)(1), in the first instance. However, there is no
evidence that the veteran's PTSD alone has caused such marked
interference with employment or necessitated frequent periods
of hospitalization for the periods at issue such as would
render impractical the application of the regular schedular
standards. In the absence of such factors, the Board is not
required to remand this matter to the RO for the procedural
actions outlined in 38 C.F.R. § 3.321(b)(1). See Bagwell v.
Brown, 9 Vet. App. 337, 338-9 (1996); Shipwash v. Brown, 8
Vet. App. 218, 227 (1995).
III. Increased Rating for Bronchitis
Factual Background
Service medical records indicate that the veteran was
diagnosed with asthma in May 1945. Service connection for
asthma was granted in an April 1946 rating decision and an
initial rating of 30 percent was assigned. A September 1947
rating decision recharacterized the veteran's disability as
chronic bronchitis and assigned a disability rating of 10
percent. Rating decisions of August 1959, October 1964, May
1981 and July 1987 continued a disability rating of 10
percent for chronic bronchitis.
A June 1996 VA examination report indicated that the veteran
reported that he was short of breath constantly. He stated
that shortness of breath woke him up at night two times a
week. On examination, the lungs were clear to auscultation.
There was mild clubbing of the fingers. The veteran reported
dyspnea on slight exertion. Chest x-rays showed chronic
obstructive pulmonary disease (COPD) with bilateral apical
pleural thickening and left basal pleural thickening, and
some left basal scarring.
A December 1996 VA examination report noted that the veteran
reported recurrent problems with shortness of breath and dry
cough. He denied any specific hospitalization secondary to
his respiratory problem. On examination, there were a few
scattered ronchi and no rales. Bases were clear bilaterally.
No cyanosis or clubbing was noted. The veteran reported
dyspnea with extreme exertion, but indicated he was alright
with slight exertion or at rest. The examiner noted mild
obstructive disease.
The veteran testified before a Member of the Board at a
videoconference hearing in August 1997. He did not offer
evidence regarding his respiratory disability.
A November 1999 VA examination report stated that the veteran
reported experiencing orthopnea. He did not report any
paroxysmal nocturnal dyspnea. The veteran was not on home
oxygen. Pulmonary function tests (PFTs) showed FEV-1 was 52
percent and FEV-1/FVC was 53 percent.
A December 2001 VA examination report indicated that the
examiner reviewed the claims file. The veteran complained of
shortness of breath on a flight of stairs. He denied chest
pain, chest pain on exertion, paroxysmal nocturnal dyspnea,
or orthopnea. The veteran did not use home oxygen. He also
denied hemoptysis, fever with chills, or night sweats. PFTs
showed FEV-1 was 43 percent. The chest x-ray was consistent
with emphysematous changes with fibrosis in both bases
consistent with chronic COPD. The examiner's impression was
that the veteran had severe COPD by PFT and by chest x-ray.
At that time, the veteran did not have a cough or any
hemoptysis, but did have frequent chronic coughs lasting for
2 to 3 months. The veteran's condition was stable on
inhalers.
Criteria
During the pendency of the veteran's appeal, VA promulgated
new regulations amending the rating criteria for respiratory
disorders, effective October 7, 1996. See 61 Fed. Reg.
46,720 (1996) (codified at 38 C.F.R. pt. 4). Generally,
where the law or regulation changes after a claim has been
filed or reopened but before the administrative or judicial
appeal process has been concluded, the version most favorable
to the veteran will apply. Karnas v. Derwinski, 1 Vet. App.
308, 313 (1991). However, when amended regulations expressly
state an effective date and do not include any provision for
retroactive applicability, application of the revised
regulations prior to the stated effective date is precluded,
notwithstanding Karnas. 38 U.S.C.A. § 5110(g) (West 2002);
DeSousa v. Gober, 10 Vet. App. 461, 467 (1997); VAOPGCPREC 3-
2000 (April 10, 2000). Therefore, before October 7, 1996,
only the previous version of the rating criteria may be
applied. Thereafter, the version more favorable to the
veteran must be applied.
Under the previous version of the regulations, a 60 percent
rating is warranted when the disability from chronic
bronchitis is severe, with severe productive cough and
dyspnea on slight exertion, and pulmonary function tests are
indicative of severe ventilatory impairment. A 100 percent
rating is assigned when disability is pronounced, with
copious productive cough and dyspnea at rest; pulmonary
function testing showing a severe degree of chronic airway
obstruction; or with symptoms of associated severe emphysema
or cyanosis and findings of right-sided heart involvement.
38 C.F.R. § 4.97, Code 6600 (1996).
Under the new regulations, a 60 percent rating is in order
where there is an FEV-1 of 40 to 55 percent of predicted; an
FEV-1 /FVC of 40 to 55 percent; DLCO (SB) of 40 to 55 percent
of predicted; or maximum oxygen consumption or 15 to 20
ml/kg/min (with cardiorespiratory limit). A 100 percent
evaluation is assigned where there is FEV-1 of less than 40
percent of predicted; an FEV-1 /FVC of less than 40 percent;
DLCO (SB) of less than 40 percent of predicted; or maximum
exercise capacity less than 15 ml/kg/min oxygen consumption
(with cardiac or respiratory limitation); cor pulmonale
(right heart failure); right ventricular hypertrophy;
pulmonary hypertension (shown by echo or cardiac
catheterization); or episodes of acute respiratory failure or
requiring outpatient oxygen therapy. 38 C.F.R. § 4.97,
Diagnostic Code 6600 (2002).
Analysis
After having carefully reviewed the evidence of record, the
Board finds that the preponderance of the evidence is against
a disability rating in excess of 60 percent for bronchitis.
The reasons follow.
Considering the old criteria, the evidence does not suggest
that the veteran has bronchitis productive of symptoms
required for a 100 percent rating. Although the December
2001 VA examiner's impression was that the veteran suffered
from severe COPD, there is no medical evidence of record
indicating that the veteran has a copious productive cough,
dyspnea at rest, symptoms associated with severe emphysema or
cyanosis and findings of right-sided heart involvement. The
December 1996 VA examination report noted shortness of breath
and a dry cough, but specifically noted no cyanosis. The
veteran reported that he experienced dyspnea with exertion,
but not at rest. In addition, the December 2001 VA examiner
specifically noted that the veteran did not have a cough at
that time, although he reported experiencing chronic coughs
that had lasted for 2 to 3 months. The veteran did report
shortness of breath on a flight of stairs, but did not
indicate that he experienced dyspnea at rest.
In addition, the evidence of record does not support a 100
percent rating under the new criteria. FEV-1 was 52 percent
in November 1999 and 43 percent in December 2001. In
addition, FEV-1/FVC was noted to be 53 percent in November
1999. There is no evidence of record of right-sided heart
involvement or episodes of acute respiratory failure
requiring outpatient oxygen therapy. The Board is aware that
the VA examination reports of November 1999 and December 2001
do not report complete findings with regard to the veteran's
PFTs. However, the Board finds that the clinical evidence of
record is sufficient for rating purposes. Accordingly, the
Board finds that the evidence does not support a rating of
100 percent for bronchitis at this time.
The above decision is based on the VA Schedule of Rating
Disabilities. In Floyd v. Brown, 9 Vet. App. 88, 96 (1996),
the Court held that the Board does not have jurisdiction to
assign extra-schedular evaluations under 38 C.F.R.
§ 3.321(b)(1), in the first instance. However, there is no
evidence that the veteran's bronchitis alone has caused such
marked interference with employment or necessitated frequent
periods of hospitalization for the periods at issue such as
would render impractical the application of the regular
schedular standards. In the absence of such factors, the
Board is not required to remand this matter to the RO for the
procedural actions outlined in 38 C.F.R. § 3.321(b)(1). See
Bagwell v. Brown, 9 Vet. App. 337, 338-9 (1996); Shipwash v.
Brown, 8 Vet. App. 218, 227 (1995).
ORDER
Entitlement to an increased initial rating for PTSD,
currently rated as 50 percent disabling, is denied.
Entitlement to an increased rating for bronchitis, currently
rated as 60 percent disabling, is denied.
____________________________________________
JEFF MARTIN
Veterans Law Judge, Board of Veterans' Appeals
IMPORTANT NOTICE: We have attached a VA Form 4597 that tells
you what steps you can take if you disagree with our
decision. We are in the process of updating the form to
reflect changes in the law effective on December 27, 2001.
See the Veterans Education and Benefits Expansion Act of
2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the
meanwhile, please note these important corrections to the
advice in the form:
? These changes apply to the section entitled "Appeal to
the United States Court of Appeals for Veterans
Claims." (1) A "Notice of Disagreement filed on or
after November 18, 1988" is no longer required to
appeal to the Court. (2) You are no longer required to
file a copy of your Notice of Appeal with VA's General
Counsel.
? In the section entitled "Representation before VA,"
filing a "Notice of Disagreement with respect to the
claim on or after November 18, 1988" is no longer a
condition for an attorney-at-law or a VA accredited
agent to charge you a fee for representing you.